Bringing Operational Efficiency Through Digital Transformation
Agile Health Tech have the proven track record of its founders and senior executives provide Healthcare enterprise product implementation and systems integration services to enable seamless communication with disparate systems, enterprise resources and external entities. We are the experts in connecting existing legacy technologies and business processes with cutting edge technologies and business trends.
Agile Health has extensive experience in Management Consulting, System Selection, Middleware selection, Implementation and Integration for large Healthcare organizations. Our management consulting in healthcare industry experts have worked in a complete evaluation of the as-is system, the current and future business needs, defining appropriate parameters and metrics for desired to be systems; multidimensional evaluation of systems and vendors.
Our System Implementation and System Integration experts have done complete business systems selection process, system implementation and configuration of Enterprise systems such as FACETS, CareAdvance, Clear Coverage, Pega, SalesForce etc. and integrated systems and business functions such as membership and claims processing system, ancillary systems such as case management, Underwritings, Rating and Quoting systems, Workflow and rules, pricing systems, claims disbursement systems, Print fulfilment etc. Our Systems Engineering capabilities include complete technical infrastructure such as integration engine, data warehouse, ETL process, automated and web enrollment system etc. Our Medical billing software that automates the healthcare billing process and connects the business goal to the technological vision of the organization and define to be a system that is aligned with the organizational objective.
Enterprise Implementation Process
Agile health tech provides medical billing software and receipt processes for client managing multiple systems of record. Many of clients needed to maintain both their legacy system and new FACETS systems simultaneously while migrating their lines of business in a phased manner. However, due to retro-active transactions, there was a need for generating invoices for members/groups migrated to new FACETS systems for the active period in a legacy system or post billing receipt for an active period in legacy system in the new system. This was a very cumbersome and labour-intensive process. We defined an automated way to lookup such retro-activity in the legacy system and created the premium billing records as BLDI ( Billing Discretionary Item) in FACETS and similarly created the process to automatically post the receipt records into FACETS instead of the legacy system. This process saved the clients 1000s of hours of manual effort.
Designing an efficient billing process for Alternate Funded Groups ( AFA Billing) with multiple source systems. One of the clients a large health plan in east coast used FACETS for their medical claims, while their dental business was outsourced to United Concordia and PBM was Optum Rx (now migrated to Prime Therapeutics). Also, the claims disbursement process was outsourced to ClearCycle. As a result, FACETS did not contain the details of the complete claims ( Medical, Dental and Pharmacy) to process AFA Billing. Our folks were involved in designing an efficient system building a claims FACT to host the adjudicated medical claims data from FACETS and reconciled that with paid claims data from ClearCycle, Dental Claims from United Concordia and Pharmacy claims from Optum; and build the application layer to generate the AFA invoices.
We strive to improve and effectively implement innovative enterprise solutions and management consulting processes in a diverse range of health care organizations. Our highly skilled business analysts efficiently connect the dots between user needs and technical requirements. Our solution architects work closely with businesses, ensuring the best-optimized solution possible.
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Client references can be provided upon request.